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Beatriz O. Reyes is a new professor in the Department of Global Health who will be teaching Community-Based Participatory Research in the Winter 2017 and 301: Intro to International Health in the Spring 2017. She is a member of the Native American Indigenous Studies Steering Group and researcher at the Foundations of Health Research Center at Northwestern.

Reyes, who is Tepehuán and a citizen of the Navajo Nation, earned her bachelor’s degree in Zoology from the University of Oklahoma. As a recipient of the Gates Millennium Scholarship and a first-generation student, Reyes initially thought being a medical doctor best suited her interests. Growing up, her experience with the U.S. health system—in particular the Indian Health Services—was less than ideal. She dreaded becoming sick because she would have to wait at the hospital for hours to be seen, which also meant her mom would have to take time off work. For her, health care was an inefficient system, and only at college did she realize that this was not an experience shared with many of her peers.

While she enjoyed studying Zoology at OU, it was connecting science to sociology and history that sent her on a path to realizing she was more interested in health policy and health disparities. As an indigenous person, she was cognizant of the ways policy shapes society’s view of her existence and the ways her experiences in the world are shaped by policy-makers. Everything from the types of foods you have access to, what land you live on, everything about your identity is shaped by these systems. Further, Dr. Heather Ketchum’s courses on Parasitology and Entomology highlighted for Reyes how human health is heavily impacted by the life cycle of insects and parasites. Reyes realized she had multiple interests but still struggled to determine where they intersected.

Reyes’s multiple experiences as an intern in the federal government provided her with a roadmap to public health. She was accepted into the Washington Internship for Native Students, a summer internship where students work for an agency in the federal government and take two classes at American University, one course being Federal Indian Law.

After this experience, she enrolled at East Carolina University to earn a master’s degree in public health. This was the first time she was exposed to public and community health, and was drawn in by its complexity. Her research project looked at the policy and implementation of recommendations for Division 1 NCAA athletes with sickle cell trait. While it was an interesting project, she wanted to further gain experience and knowledge in qualitative research methods and community-based participatory research. She then decided to pursue a doctorate in Health Policy and Social Justice at the Dornsife School of Public Health at Drexel University in Philadelphia, Pennsylvania. Her doctorate research focused on evaluating a faith-based 16-week prediabetes prevention program. This larger study was conducted by her advisor, Dr. Nicole A. Vaughn and was an adaptation of the National Diabetes Prevention Program (DPP). Reyes’s dissertation study was a qualitative analysis of the ways lay health educators adapted and utilized program materials to fit the needs and concerns of their specific communities.

Reyes hopes to provide Northwestern undergraduates with an introduction to the benefits and challenges of collaborations between researchers and communities, in her Winter 2017 course on Community-Based Participatory Research (CBPR). She told me, “The thing about CBPR is that it’s not a method, it is a paradigm, it’s an approach to research.” It begins with asking yourself questions like: where does the community fit into developing the research question, decision-making process and resulting intervention? Does the community find value in the research and intervention? Is there joint ownership of the data, its presentation, and implementation? While there is no standard way to do CBPR, it is so important to remove the barriers that prevent researchers from working with communities, and one of the most powerful ways of doing this is by coming together with a shared vision of improving health in a socially just manner with the intent to eliminate health disparities.

Dr. Young joined the Northwestern Department of Anthropology and Program in Global Health Studies this year. Her work focuses on maternal and child undernutrition in low-resource settings, particularly sub-Saharan Africa. “Everything I do focuses on what you call ‘the first thousand days,’ which is the year before delivery and the two years after. The people who struggle the most in that time are those with insufficient resources,” she said. “Some of the research I do involves people who are experiencing food insecurity, mothers who are micronutrient deficient, the implications of water insecurity and those who crave consumption of non-foods–known as pica.”

She received her bachelor’s degree in Anthropology from the University of Michigan. She then studied medical anthropology (MA, University of Amsterdam), international nutrition (PhD, Cornell University) and HIV (Fellowship, University of California – San Francisco).

What inspired your research?

When I was an undergraduate at the University of Michigan, I went to West Africa as a field assistant doing anthropometry, measuring height, weight and upper arm circumference. There, I studied anthropology of religion, and how people make meaning of what the world is. When I got there, there were health problems I couldn’t have even imagined, and the high infant mortality rate caught my attention.

What is the intersection of Anthropology and Global Health?

We often think that we can fix health problems when we understand the virus, the cell or the toxin–all the physiological causes of poor health. Although these are the actual causes of health outcomes, something happens before a virus is transmitted or before a toxin is ingested. That’s what’s really interesting to me. You can make a distinction between pre-dental and post-dental nutrition. There’s everything that happens with food before it crosses our teeth, and then there’s everything that happens after you swallow it–the biochemical side of things. In my opinion, the biochemical side is necessary but not sufficient for understanding the major global health problems we see in the world. You could say that my research group’s focus is on pre-dental nutrition.

What were your most meaningful international research experiences?

My heart was captured by my time in West Africa. A few years after, I went to Zanzibar in East Africa, which was a vastly different world, and lived with several different Swahili families. This experience led me to my master’s project on maternal anemia, which led me to complete a doctorate in nutrition. These experiences were important to me professionally, but they also shaped my worldview, for example the importance of cross-cultural understanding and embrace of different ideas.

What is the most pressing factor we should address in regard to maternal and child health?

Undernutrition is a huge problem. There are a lot of causes of poor health, and illnesses kill millions every year. But there’s this concept called “potentiating effect of undernutrition” which is a fancy way of saying that poor nutrition is the underlying cause of death in cases that don’t seem nutrition related, like pneumonia. If a well-nourished child contracts a virus, they’ll become sick, but then they’ll get better. If a poorly-nourished child contracts the same virus, they’ll be much less likely to recover.

Another issue related to undernutrition is breastfeeding. If more babies got more breastmilk for long periods of time, there would be economic benefits, cognitive development benefits and so much more.

Lastly, food insecurity among women and children is really high, even right here in the United States. It is associated with many bad outcomes in terms physical and mental health, cognitive development, and economic productivity.

What is the leading contributor to food insecurity?

There’s plenty of food in the world, and if that was evenly distributed, problem solved. But the issue at hand is equitable distribution.

I also want to bring up the topic of water insecurity. We often think of water insecurity being in drought-ridden nations, but it’s right here as well. The consequences haven’t really been studied, so that’s something I’d like to explore with undergraduates.

Dr. Young will be teaching a course in Winter 2017 called “Ecology of Infant Feeding: A global perspective on the best ways to feed babies.” The course will introduce students to the health and social consequences of practices such as breastfeeding, bottle feeding and complementary (non-milk) foods.

“The whole world, all human life, is one story.” We as humans are hard wired for the listening and telling of stories. Our stories define who we are as individuals, and as a community. If we wish to have meaningful and strong relationships in our lives, we must be able to listen effectively. We can choose what we hear and what we do not hear, what we listen to and what we do not listen to. While one can hear without any specific purpose, listening takes purposeful self-awareness, focus, and unselfconsciousness. Northwestern professor Lynn Kelso, who has devoted her life to the art of storytelling, says it best: “Hearing is a sense. Listening is an art.”

Northwestern Community Health Corps is a student organization focused on empowering community members to take charge of their own health through the implementation of informational health desks located in libraries. As volunteers at the health desk, we sought the advice of Professor Kelso in order to improve our ability to be empathetic and active listeners when hearing health narratives from desk patrons. Storytelling or patient narrative plays a central role in the health care provider-patient relationship. As Kelso illuminated, the ability of any healthcare professional to actively listen to the stories of patients will define their capacity to treat their patients effectively. Patients must believe that they can truthfully and comfortably share their story with someone who will listen in a non-judgmental way. They must not feel that they have to say what the healthcare provider wants to hear, nor feel that they must align with the healthcare provider’s religious, cultural, or social beliefs about the practice of medicine.

In order to be effective and empathetic listeners of narrative, Kelso emphasized that healthcare providers must take the “I” out of the conversation. In other words, the listener must not talk about his or herself and rather focus intently on the speaker. More so, Professor Kelso contends that 90 percent of communication between the teller and the listener occurs through non-verbal body language. Your eye contact, posture, voice tone and responses reveal if you are truly listening. This emphasizes why active listening cannot occur through non-in person communication methods, such as texting.

Health care providers must learn to be attentive, active, and engaged listeners in order to provide patient centered and culturally competent care. In order for healthcare professionals to receive this listening training, a multi-disciplinary collaborative approach is necessary. The healthcare sector must seek advice from those who specialize in speaking and body language, such as Kelso who hails from the theatre department here at Northwestern.

This push for multisector collaboration in developing listening skills of health care providers, has been reflected in the newly developed Feinberg curriculum which places an emphasis on medical humanities and communication training. Medical students, both here at Feinberg as well as other medical institutions across the country, are now required to take courses in the medical humanities, in order to aid in their ability to decipher narratives and communicate effectively with their patients. Even this quarter in Weinberg, Hosanna Krienke has been leading an English course focused on the medical humanities. I am a student in the course, and she has encouraged us as future healthcare providers to pay close attention to narrative, the way in which we listen, and most importantly the language we use to communicate. Words have the power to shape the physician-patient relationship, and thus should be used only with specific purpose and acute awareness of language’s ramifications. In order to understand what language will define our vernacular as future healthcare providers, we must start with listening to every patient’s narrative. As Kelso says, “listen to your world and the stories they tell. They are all a part of your story.”

Northwestern GlobeMed’s research team, Udita Persaud, Jimmy Wester, Camille Cooley, and Aysha Salter-Volz, received funding from the Radulovacki Global Health Research Fellowship to conduct research in the communities surrounding their partner organization, the Adonai Child Development Centre, in Uganda.

Tell us about your project.

Udita: Globe Med has a partner organization in Namugoga, Uganda and we go every year to evaluate our partnership and do research. Our research focused on looking overall at the assets and resources in the community and how people seek healthcare, who they go to healthcare, how they think about healthcare. We got to use really cool qualitative research methods along with community-based participatory research methods.

Camille: We spent six weeks in Namugoga, Uganda, which is a village about an hour and half outside the capital, Kampala. We were able to interview a lot of people in the local village but the area is very dense in terms of the number of villages that are there and the number of communities. So we got to meet a lot of interesting people and hear a lot of really interesting perspectives and make a lot of really great friends there as well. So I think we all really miss it.

Why did you decide to research this topic this year?

Aysha: I think in the past a lot of the research for Globe Med has had a very narrow focus and we wanted to do something that was more holistic and that gave our organization a better understanding of the community for future projects. Also it hadn’t really been done before and [in GlobeMed’s past research] we weren’t really getting the breadth of knowledge since we were focusing more on individual cases.

Jimmy: I think in past years we’ve had very focused research without that foundational knowledge of how the community functions or how the whole system works. We wanted there to be less discontinuity from year to year so we thought having this background would be really beneficial research for years to come. When we end up doing more specific research, we’ll have a way better understanding. With that, Camille was working on a pre-departure guide. Orientation and pre-departure materials will help other groups moving forwards so that they have a better foundation.

Camille: I think in the past, a lot of the teams going in didn’t know what to expect. It was very much a learn-as-you-go process. We were able to accumulate a lot of the knowledge we gained through the entire process and I’ve managed to put it in a pre-departure guide for future teams which I think will be pretty helpful in supporting whatever future research occurs.

What kind of preparation did you all have?

Udita: I think that was a big problem because there’s no pre-departure and we’re not part of any set program, which can be really difficult because you don’t even know what to expect. We did talk to the student who went last year—a couple of us had dinner with them. We were able to ask them questions but for the most part, we were going into it blind.

What was your most meaningful experience abroad and what did you learn from it?

Camille: I think one of the moments that stood out was during an interview. One of the interviewees had been interviewed the year before and really wanted to know what came out of this research, and really wanted to know what we were doing to give back to the community. That was very powerful to me because the community is very invested in the people that live there, and really want to make sure that the work that gets done is moving everyone forward. To me that was a very powerful moment in regards to the potential impact we have in communities abroad.

Jimmy: I remember some interviews where people were critical of the work we were doing and making sure that they were holding us accountable. When we came in, they were like, “oh we remember you guys from last year. You asked us so many questions last year, what’s come of that?” Obviously we are not directly accountable for the work of last year’s team, but we want to be able to have at least some identifiable change that we have accomplished. That really coalesced to a higher standard and made us want to do better and make sure that we are in communication with next year’s team.

Udita: We also got funding to have a partnership as part of our research to make our work more sustainable. We tried to do this through a partnership where Northwestern students and Ugandan students can come together and do research together. It’s often challenging when undergraduate students come to another country that they don’t have a lot of knowledge about. So Ugandan students can come in and help guide us through this. We can also learn a lot about research together. So we’re trying to put that together for next year.

What was your most challenging moment or aspect, and how did you cope?

Aysha: I had a really hard time being abroad the whole time but it was really cool to just realize that I was in a different country and there was so much there that I would have never been able to experience otherwise. For many reasons, it was very grounding to interview people and realize that I was in a completely different part of the world but at the same time just with people. So that made it better but it was still very difficult. More specifically, it was difficult combatting mixed feelings about why we were there and whether or not our research was actually worthwhile for the community or whether we were inadvertently exploiting that for our own academic agenda. Even though we wanted to do something that was for them, it was harder to reconcile different power dynamics. So on top of the challenge of being abroad, having that cognitive dissonance was really hard to justify.

Udita: Also, our research just didn’t get cleared [by the Ugandan research board] in the beginning, which was a big set back for us. Whenever you go abroad, that’s something you don’t think about. We did everything in our power and did everything we should have done and we got there and they were like, these are not the right things. You haven’t gone through the necessary protocols. Having to deal with that is really hard and not knowing where to turn is really hard because your principal investigator is here in Evanston and maybe doesn’t know how they do things in Uganda. So that was really hard for us in the beginning because we didn’t even know if we could do our research.

How do you think your experiences have impacted your future goals and interests at Northwestern or after? Both as individuals and for Globe Med moving forward?

Camille: Personally, it’s reaffirmed my passion for health. I know I want to stay in the health field and focus on public and global health, which has been really gratifying. If anything I think the trip itself has led to a lot of questions. For example, in what capacity do I want to work in this field? Is global health or public health the right fit for me? It was overall a great experience in shaping how I see my future and my career goals. I think in terms of Globe Med, we mentioned an upcoming partnership and that will be a huge part of how Globe Med evolves and how we mediate the relationship between our partner and our students. If anything, I think it’s going to make our relationships with the people in Uganda richer. I think chapter members are going to be able to have more substantive experiences that they can hear about from future research team members.

Udita: As a graduating senior, I think it’s reaffirmed a lot of things I like to do and brought up a lot of questions that I have with engagement abroad and how we work in global health abroad. I really like thinking about things like capacity building and partnership building. I want to continue doing that because I have a lot of questions that still don’t have answers.

Aysha: Similar to Camille, going abroad and doing the research got me thinking constantly about health related issues which reaffirmed that I want to do something in health. It also made me realize that I want to work internationally and also focus on health issues domestically too. A lot of the time it was interesting to be so far away learning about health disparities in that community and think about how that wasn’t my community. There are so many health disparities within our own communities back here. I think I also learned a lot about Globe Med that I didn’t really realize before and would not realized if I hadn’t gone on the trip.

Jimmy: It was a very positive experience over all, but at the same time it allowed me to think very critically about international involvement. We definitely benefitted the community in some capacity but at the same time I had to question how much good we are actually doing. So with that, I think I still want to go into the health field but I want to be more present within whatever community I am involved in. It also made me understand the importance of qualitative research since I think I am more prone to the medical standpoint of wanting to be as efficient as possible.

Do you have any advice for students wishing to conduct research in an unfamiliar location?

Udita: We all did a lot of prep work before we went abroad and tried to make our design as reasonable as possible. So going there and finding out nothing turned out the way you expected shows you really need to gain knowledge about where you are going and have someone there who is there to advise you in country. Having connections wherever you are researching in the academic field. You also need to be very open and flexible with whatever might come your way.

Jimmy: Not to be cliché, but be genuine, be present, and don’t be afraid to ask for help. It’s always hard being in a new community so it’s important to show that you care about the work that’s being done.

What do you hope to do with this work?

Udita: We just got our last couple of transcripts back and now we’re trying to compile it all into a comprehensive report before the end of this quarter. We have already had the chance to present preliminary findings to the community, which was an amazing experience. We hope to have the final report translated [into the local language] for our partner organization so that they can disseminate that report to the community members, especially the community leaders.

Jimmy: Our last week there, we had a focus group with village health workers as well as a discussion with community leaders and during both of those, people expressed a lot of interest in getting a copy of the report from this year.

Dr. Prasad is the kind of doctor you want treating your family and community.

His story began in South India. In 1992, there was a cholera epidemic in the entire district but no one died from the infectious water-borne disease. This was due to the fact that for the past three years, the community had been talking about and working towards water hygiene. Prevention, according to Dr. Prasad, is not very “sexy”. It does not require any high tech magic-bullet solutions. In this community, the life-or-death intervention was finding where people collect water and wash their clothes.

“What is primary care?” Dr. Prasad asked us, and we gave the usual responses: treating basic health issues, providing vaccinations and treating families and communities. He introduced us to the model of the “five C’s” of primary care: first contact, continuity, comprehensive, coordination, and community. Primary care professionals are at the frontline of medicine. They are often the first person both the sick and the well encounter, and as we all know, first impressions are very important. The patient’s first interaction with a physician can determine their future relationship with the whole field of medicine. If patients feel misunderstood, disrespected or fearful, they will be much less likely to come back for future checkups or to seek care for serious health conditions. This is where continuity comes into play. Primary physicians are there for the long term – for the vaccinations, height measurements, yearly checkups, sexual health education, chronic diseases and beyond. Our bodies exist in and interact with our social worlds. Only physicians who know who you are, not only your family history but your healthy and unhealthy habits and all the social determinants that affect your unique health and body, are equipped to treat you with the dignity and knowledge that all people deserve. Comprehensive and coordinated health care requires this contextual understanding, so that diabetics, for example, not only receive a prescription for medicine, but are also referred to a nutritionist, psychiatrist, shelter, or any necessary financial resources. The final “C”, community, is how individual health becomes part of a greater and healthier whole. As the final piece of the puzzle, this is where long-term changes in overall health can occur.

The current U.S. healthcare system excels at treating illness. Promoting wellness, on the other hand, is not a political or financial priority. Following the Neo-Darwin organism theory, interventions only occur after the absence of health and manifestation of illness. The success of a system based on curing rather than preventing is much easier to quantify and evaluate, but at what cost (pun intended)? Hospitals and clinics lack the metrics to determine wellness and evaluate preventative measures. Dr. Prasad, however, has his own “grand slam” metrics: questions like, “how are you doing today?” “how are things with your family?” and “do you feel like you are being taken care of here?”

Dr. Prasad showed us a quote: “Our concept of health is to make social change”. His advice? Get involved in family medicine. Following that statement, he told us he may or may not be biased on the matter.

An innovator in primary care, Dr. Prasad is a practicing physician and lecturer working at the intersections of medicine and public health, including training providers on issues of racism and inequality, improving quality of healthcare in rural areas, and conceptualizing ways that medicine can address wider social determinants of health—issues that can only be addressed outside the clinic.